Shepcain Fortified procaine penicillin Injection## (check active ingredients, strength format)

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Bicillin C-R and other antibacterial drugs, Bicillin C-R should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. …

• Streptococcal Infections Group A Infections of the upper-respiratory tract, skin and soft-tissue infections, scarlet fever, and erysipelas
• The following doses are recommended: Adults and
• Pediatric patients over 60 lbs. in weight: 2,400,000 units
• Pediatric patients from 30 to 60 lbs.: 900,000 units to 1,200,000 units
• Pediatric patients under 30 lbs.: 600,000 units
• NOTE: Treatment with the recommended dosage is usually given at a single session using multiple IM sites when indicated
• An alternative dosage schedule may be used, giving one-half (1/2) the total dose on day 1 and one-half (1/2) on day 3
• This will also insure the penicillinemia required over a 10-day period; however, this alternate schedule should be used only when the physician can be assured of the patient's cooperation
• Pneumococcal Infections (except pneumococcal meningitis) 600,000 units
• Pediatric patients and 1,200,000 units
• Adults, repeated every 2 or 3 days until the temperature is normal for 48 hours
• Other forms of penicillin may be necessary for severe cases
• Method of Administration Bicillin C-R is intended for Intramuscular Injection ONLY
• Do not inject into or near an artery or nerve, or intravenously or admix with other intravenous solutions. (See WARNINGS section)

(See INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION sections.)

Clinical studies of penicillin G benzathine and penicillin G procaine did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. …

• Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly
• Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue
• Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. …

A previous hypersensitivity reaction to any penicillin or to procaine is a contraindication.

Tetracycline, a bacteriostatic antibiotic, may antagonize the bactericidal effect of penicillin, and concurrent use of these drugs should be avoided. Concurrent administration of penicillin and probenecid increases and prolongs serum penicillin levels by decreasing the apparent volume of distribution and slowing the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. …

WARNING: NOT FOR INTRAVENOUS USE. DO NOT INJECT INTRAVENOUSLY OR ADMIX WITH OTHER INTRAVENOUS SOLUTIONS. THERE HAVE BEEN REPORTS OF INADVERTENT INTRAVENOUS ADMINISTRATION OF PENICILLIN G BENZATHINE WHICH HAS BEEN ASSOCIATED WITH CARDIORESPIRATORY ARREST AND DEATH. Prior to administration of this drug, carefully read the WARNINGS , ADVERSE REACTIONS , and DOSAGE AND ADMINISTRATION sections of the labeling. The combination of penicillin G benzathine and penicillin G procaine should only be prescribed for the indications listed in this insert. Anaphylaxis SERIOUS AND OCCASIONALLY FATAL HYPERSENSITIVITY (ANAPHYLACTIC) REACTIONS HAVE BEEN REPORTED IN PATIENTS ON PENICILLIN THERAPY. …

As with other penicillins, untoward reactions of the sensitivity phenomena are likely to occur, particularly in individuals who have previously demonstrated hypersensitivity to penicillins or in those with a history of allergy, asthma, hay fever, or urticaria. The following adverse reactions have been reported with Bicillin C-R during post-marketing experience: Skin and Appendages: Stevens-Johnson syndrome (SJS) and drug reaction with eosinophilia and systemic symptoms (DRESS) (See WARNINGS .) The following have been reported with parenteral penicillin G (the active moiety in Bicillin C-R): General: Hypersensitivity reactions including the following: skin eruptions (maculopapular to exfoliat …

Pregnancy Teratogenic effects Reproduction studies performed in the mouse, rat, and rabbit have revealed no evidence of impaired fertility or harm to the fetus due to penicillin G. Human experience with the penicillins during pregnancy has not shown any positive evidence of adverse effects on the fetus. …

Penicillin in overdosage has the potential to cause neuromuscular hyperirritability or convulsive seizures.

Store in a refrigerator, 2º to 8º (36º to 46ºF). Keep from freezing.

Take it when you remember, unless it is nearly time for the next dose. Then skip the missed one. Never take two doses at once to make up for it. Check your leaflet, as some medicines are different.